Healthcare Provider Details

I. General information

NPI: 1770082356
Provider Name (Legal Business Name): RESTORE MEDICAL PARTNERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 S TAMIAMI TRL UNIT 115
SARASOTA FL
34238-2901
US

IV. Provider business mailing address

333 TAMIAMI TRL S STE 101
VENICE FL
34285-2425
US

V. Phone/Fax

Practice location:
  • Phone: 941-375-3006
  • Fax: 941-218-4825
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY JOB
Title or Position: OWNER
Credential:
Phone: 941-375-3006